Before surgical repair became available, d-TGA was a lethal condition with an average life expectancy at birth of 0.65 years [2]. When open-heart surgery became feasible in the mid-1950s, survival changed dramatically. In the contemporary era, d-TGA has become a well-treatable condition and survival to adulthood is the rule [3, 4].

The first widely used repair technique was the atrial switch operation (Senning or Mustard procedure) with redirection of the venous blood flow at the atrial level [5, 6]. By the late 1980s, the arterial switch operation (Jatene operation) with redirection of blood flow at the level of the great arteries superseded the atrial switch procedure [7]. For the small subset of patients with d-TGA, concomitant ventricular septal defect and pulmonary stenosis, the Rastelli operation was and is an important surgical option [8]. Although the atrial switch operation is no longer performed today, the majority of patients who underwent this operation are still alive and there remains a substantial cohort of women in the childbearing age. As a consequence, all three repair techniques may be encountered in women of childbearing age. Relevant aspects of physiology, long-term complications and pregnancy-specific problems regarding these three types of repair will be discussed below.

Long-term outcomes of patients with repaired d-TGA are largely determined by the type of repair and type and severity of residual haemodynamic lesions. The most common long-term complications in patients after atrial switch repair are arrhythmias (particularly atypical atrial flutter and sinus node dysfunction) and progressive dysfunction of the subaortic right ventricle with or without progressive systemic tricuspid valve regurgitation. Furthermore, baffle obstruction and baffle leaks as well as pulmonary hypertension can occur. On average, this patient group has substantially reduced exercise capacity compared to the general population [9]. Cardiac complications become more common as patients age. These patients have a reduced life expectancy, which is important for pre-pregnancy counselling. There is however a wide range in individual variation of disease courses. Long-term follow-up data beyond the fifth decade of life is not yet available.

The majority of adult survivors after the arterial switch operation are still young, and their outcome beyond the third decade of life is not yet known. To date, it seems that subaortic ventricular dysfunction and arrhythmias are less common compared to patients after the atrial switch operation [10–12]. The main reason for re-intervention is obstruction of the branch pulmonary arteries. Potential long-term complications include neo-aortic root dilatation, neo-aortic valve regurgitation or obstruction of the reimplanted coronary arteries [13, 14]. Survival to adulthood is the rule but lifelong specialised follow-up remains mandatory.

In patients after the Rastelli repair, re-intervention due to deterioration of the right ventricular-pulmonary artery conduit is inevitable. Subaortic left ventricular dysfunction and arrhythmias are relatively common. In the largest published series on long-term outcomes after Rastelli repair, overall freedom from death and transplantation was 52 % at 20 years [15]. In contrast, in the Canadian cohort, the estimated survival at 17 years of follow-up was 89 % [16].

Data regarding pregnancy outcomes in women with the atrial switch operation are limited to several medium-sized and smaller retrospective case series [17–23]. Reports of pregnancy outcomes in women after the arterial switch operation and Rastelli repair are sparse [24, 25]. Reported pregnancy outcomes of series of patients with repaired d-TGA are summarised in Table 8.1 [26].